Extracellular Vesicles (EVs) Play Key Role in Pathology of Malaria Caused by Plasmdium vivax; EVs Promote Adherence of Parasites to Cells in Spleen, Where Parasites Can Remain “Hidden” and Cause Severe Disease Despite Low Parasitemia in Peripheral Blood

Plasmodium vivax is the most widely distributed human malaria parasite, mostly outside sub-Saharan Africa, and responsible for millions of clinical cases yearly, including severe disease and death. The mechanisms by which P. vivax causes disease are not well understood. Recent evidence suggests that, similar to what has been observed with the more lethal Plasmodium falciparum, red blood cells infected by the parasite may accumulate in internal organs and that this could contribute to the pathology of the disease. In fact, the team led by Hernando A. del Portillo, PhD, and Carmen Fernández-Becerra, PhD, both of the Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, recently showed that P. vivax-infected red blood cells adhere to human spleen fibroblasts thanks to the surface expression of certain parasite proteins, and that this expression is induced by the spleen itself. "These findings indicate that the spleen plays a dual role in malaria vivax," says ICREA (Catalan Institution for Research and Advanced Studies) researcher Dr. del Portillo. "On one hand, it eliminates infected red blood cells. On the other hand, it may serve as a "hiding" place for the parasite." This could explain why P. vivax can cause severe disease in spite of low peripheral blood parasitemia.” The new results were reported online on June 2, 2020 in Nature Communications.
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